DF/HCC Program Affiliation

Gynecologic Cancer

Research Abstract

Primary debulking surgery for advanced ovarian cancer: the past, present or future?

Schorge JO, Growdon WG, Munro EG, Del Carmen MG, Boruta DM, Goodman AK. MGH Gynecologic Oncology, Boston

Objective: The efficacy of primary debulking surgery (PDS) for ovarian cancer was initially demonstrated in New England in the late 1970s and became standard of care. More recently, neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS) has been increasingly championed. We reviewed our experience with newly diagnosed advanced ovarian cancer in order to determine our provision of care.

Methods: We prospectively collected data on all women with newly diagnosed stage IIIC/IV epithelial ovarian cancer who underwent primary therapy at MGH from 5/08-5/09. Pathology was reviewed and treatment planning discussed at our weekly multidisciplinary tumor board conference.

Results: 42 patients were treated having a median age of 62 years. 31 patients had stage IIIC disease and 32 had pap serous histology. 35 women (83%) underwent PDS and 7 NACT with IDS. Overall, 64% were optimally debulked to < 1 cm residual disease and there was a trend toward a lower rate in PDS patients (60 v 86%; P = 0.39). Debulking surgery involved lymphadenectomy (31%), bowel resection (29%), splenectomy (17%), and diaphragmatic surgery (14%). Major postoperative morbidity was comparable between PDS and NACT/IDS patients (40 v 28%; P = 0.69). The median day of discharge was 8 (range, 3-28). 11 women (26%) were enrolled in a clinical trial.

Conclusions: Both PDS and NACT/IDS have a role in the initial treatment of women with advanced epithelial ovarian cancer. We hope our data will stimulate discussion of current practice in New England.

Publications

• Wingo SN,Gallardo TD,Akbay EA,Liang MC,Contreras CM,Boren T,Shimamura T,Miller DS,Sharpless NE,Bardeesy N,Kwiatkowski DJ,Schorge JO,Wong KK,Castrillon DH.Somatic LKB1 mutations promote cervical cancer progression.PLoS ONE 2009;4(4):e5137.
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• Miller DS,Blessing JA,Bodurka DC,Bonebrake AJ,Schorge JO.Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group.Gynecol Oncol 2008 Jul;
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• Gagnon A, Kim JH, Schorge JO, Ye B, Liu B, Hasselblatt K, Welch WR, Bandera CA, Mok SC.Use of a combination of approaches to identify and validate relevant tumor-associated antigens and their corresponding autoantibodies in ovarian cancer patients.Clin Ca
  18245537
• Oh JH,Nandi A,Gurnani P,Knowles L,Schorge J,Rosenblatt KP,Gao JX.Proteomic biomarker identification for diagnosis of early relapse in ovarian cancer.J Bioinform Comput Biol 2006 Dec;4(6):1159-79.
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• Makarla PB,Saboorian MH,Ashfaq R,Toyooka KO,Toyooka S,Minna JD,Gazdar AF,Schorge JO.Promoter hypermethylation profile of ovarian epithelial neoplasms.Clin Cancer Res 2005 Aug 1;11(15):5365-9.
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• Schorge JO, Drake RD, Lee H, Skates SJ, Rajanbabu R, Miller DS, Kim JH, Cramer DW, Berkowitz RS, Mok SC.Osteopontin as an adjunct to CA125 in detecting recurrent ovarian cancer.Clin Cancer Res 2004 May 15;10(10):3474-8.
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• Ye B, Cramer DW, Skates SJ, Gygi SP, Pratomo V, Fu L, Horick NK, Licklider LJ, Schorge JO, Berkowitz RS, Mok SC.Haptoglobin-alpha subunit as potential serum biomarker in ovarian cancer: identification and characterization using proteomic profiling and mas
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• Kim JH, Skates SJ, Uede T, Wong Kk KK, Schorge JO, Feltmate CM, Berkowitz RS, Cramer DW, Mok SC.Osteopontin as a potential diagnostic biomarker for ovarian cancer.JAMA 2002 Apr 3;287(13):1671-9.
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